Conclusions

Changing antiretroviral therapy early during pregnancy with the goal of improving fetal and pregnancy outcomes did not seem to have a destabilizing effect on viral suppression. To avoid exposing the fetus to potentially harmful medications, multidisciplinary care and discussion with each woman should be encouraged, and the optimal treatment regimen should be chosen preconceptionally. As guidelines evolve, it is also important to inform clinicians. Since a large number of effective antiretroviral regimens are now available, the choice of which ones to use requires adequate data on their risks. This requires ongoing research, including follow-up in cohort studies and randomized controlled trials.